The Emergency Physician will decide which service to consult for admission considering the following:
Patients returning within 30 days of discharge will be the responsibility of the discharging service, unless there is a clear and unequivocal reason to do otherwise (e.g. acute Ml needing CCU or telemetry after hospitalization for abdominal pain by General Surgery). In the case of disagreement, the service that previously admitted the patient is primarily responsible.
Patients followed by a specialist from any Edmonton Zone site on a regular basis (2 visits or greater in the preceding year) with a presenting illness related to that specialist's system will be referred to that service. Each Department will be responsible for establishing internal mechanisms for covering Divisions or programs that do not have their own inpatient beds.
Patients followed by a specialist who present with an unrelated diagnosis will be referred to the appropriate alternative service. (In the case of disagreement between services the guidelines outlined in 3.0 to 3.2 will be followed).
If after assessment, the consulted service establishes a different diagnosis which it feels would be better managed by an alternative service, then the patient may be referred to that alternative service for further management. To facilitate dialogue, the primary consulted service should communicate their concerns and rationale to the alternative service directly by way of attending-to-attending* handover and discussion. The Emergency physician should be notified by the primary consulted service once this discussion has taken place.
One of the first 2 consulting services will admit the patient unless there is agreement to admit from another service.
Any disagreements will be discussed first by the staff attending physicians involved. If agreement cannot be reached, a random selection process will be used to assign responsibility for the patient.
All cases requiring random assignment will be reviewed by the Service Chief of the Emergency Department, with the Service Chief of the consulted Department(s)/Division(s), and the Site Medical Director or Site Quality Council to decide if appropriate actions were taken and/or if the guidelines or allocation of resources needs modification.
Physician Consult Response Time
Service response
STAT (Urgent) - 5 minutes – call must be made directly by Emergency physician to attending* physician and hospital team.
Call for consultation: Initial call for consultation should be directed to on-call service.
Telephone response to emergency by consulting service - within 15 minutes.
Attendance in emergency to conduct consult - within 2 hours.
If a necessary test is ordered or pending - when test is complete.
A final decision regarding admission must be made within 2 hours of the patient being assessed by that service.
All patients MUST be reviewed by attending* staff that has the experience and authority to make clinical and disposition decisions.
Service failure to respond
If a service does not evaluate the patient within 2 hours of request for consultation, the responsible attending physician will be contacted by the Emergency Physician.
If a patient has been deemed appropriate for a service and the final disposition decision has not been made within 2 hours of the Emergency Physician speaking to that service, the attending physician will be contacted to decide on disposition.
A service directly accepting a patient in transfer to the Emergency Department (ED) is responsible for the patient. The accepting service may request that the patient be assessed by the Emergency Physician by discussing with them ahead of time. The accepting physician may admit the patient or transfer the patient back to referring facility but the accepting service is responsible for the patient's management and is responsible for arranging a timely disposition. If an alternative service is required then the accepting physician shall contact the second service as per principles set out in 2.0.
A service accepting a patient as a direct transfer to the ED must call the ED Charge Nurse / Unit Manager through RAAPID North to confirm that the ED has space/resources available to appropriately care for the patient. If the ED resources are not available, the accepting physician must work with the ED Charge Nurse / Unit Manager and Utilization Manager to address resource needs.
The service accepting a patient must have an appropriate disposition decision finalized within 4 hours of arrival in the ED or by default the patient will be admitted to the accepting physician after appropriate notice is made to the accepting physician.
Patient transfers from another acute care inpatient facility must have an accepting admitting physician (inpatient service) at the UAH as per AHS Business Rule on Transfers between EZ Emergency Departments.
Patient referrals and transfers from outside the region must be coordinated through RAAPID North as per protocol.
Consultants failing to follow this process will be expected to meet the patient in the ED promptly upon arrival to determine what services will be required.
Transfer of Critical Care patients from another hospital must always be approved by the ICU physician on-call, through RAAPID North as per protocol.
Patients transferred from the Kaye Edmonton Clinic shall follow the protocol outlined by the KEC.
Our work takes place on historical and contemporary Indigenous lands, including the territories of Treaty 6, Treaty 7 & Treaty 8 and the homeland of the Métis Nation of Alberta and 8 Métis Settlements. We also acknowledge the many Indigenous communities that have been forged in urban centres across Alberta.
